Healthcare Provider Details

I. General information

NPI: 1417191420
Provider Name (Legal Business Name): SEAN PATRICK BRADY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 SANDIFUR PARKWAY
PASCO WA
99301
US

IV. Provider business mailing address

560 GAGE BLVD SUITE 203
RICHLAND WA
99352
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3170
  • Fax: 509-543-9795
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-942-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP60341437
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: